Neurology

Impaired consciousness, Headache, Raised intracranial pressure, Acute bacterial meningitis, Epidemic meningococcal disease, Viral meningitis, Chronic meningitis, Encephalitis, Rabies, Tetanus, Stroke, Subarachnoid haemorrhage, Subdural haemorrhage, Extradural haematoma, Blackouts/syncope, Space-occupying lesions (SOL), Brain abscess, Hydrocephalus, Epilepsy, Status epilepticus, Cysticercosis, Weak legs and spinal cord disease, Guillain-Barré syndrome, Poliomyelitis (polio), Peripheral neuropathy, Leprosy, Dementia

DIAGNOSIS AND MANAGEMENT OF ACUTE EXTRADURAL HAEMATOMA-A 6 YEARS STUDY AT MEDICAL COLLEGE HOSPITAL,BIKANER

Background:Extradural haematoma refers to an extra-axial accumulation of blood between the dural lining of brain and the inner table of skull. Acute EDH may expand rapidly and it is a neurosurgical emergency requiring prompt surgical evacuation. Methods:This research article is based on diagnosis and management of acute EDH in the neurosurgery department of SP medical college and associated group of hospitals,Bikaner in the 6 years duration from 2014 to 2020.It comprises of the evaluation of 235 cases of acute EDH who underwent surgical evacuation of the haematoma. Results:Following surgical treatment,83.83% of the acute EDH patients had a favourable outcome in our study group. Conclusion:CT scan is the most reliable diagnostic modality for EDH.Timely intervention can be life saving in this potentially life threatening emergency.There is excellent functional outcome after surgical evacuation when the EDH is rapidly detected and evacuated.

Prophylactic use of dural tenting sutures in elective craniotomies in adults—is it necessary? A study protocol for a multicentre, investigator- and participant-blinded randomised, parallel-group, non-inferiority trial

Background In the early days of neurosurgery, extradural haemorrhages (EDHs) contributed to a high mortality rate after craniotomies. Almost a century ago, Walter Dandy reported dural tenting sutures as an effective way to prevent postoperative EDH. Over time, his technique gained in popularity and significance to finally become a neurosurgical standard. Yet, several retrospective reports and one prospective report have questioned the ongoing need for dural tenting sutures. Dandy’s explanation that the haemostasis observed under hypotensive conditions is deceiving and eventually causes EDH may be obsolete. Today, proper intra- and postoperative care, including maintenance of normovolemia and normotension and the use of modern haemostatic agents, may be sufficient for effective haemostasis. Thus, there is a fundamental need to evaluate the necessity of dural tenting sutures in a solid, unbiased, evidence-based manner. Methods This study is designed as a randomised, multicentre, double-blinded, controlled interventional trial with 1:1 allocation. About one half of the participants will undergo craniotomy without dural tenting sutures and will be considered an intervention group. The other half will undergo craniotomy with these sutures. Both groups will be followed clinically and radiologically. The primary outcome is reoperation due to extradural haematoma. Secondary outcomes aim to evaluate the impact of dural tenting sutures on mortality, readmission risk, postoperative headaches, size of extradural collection, cerebrospinal fluid leak risk and the presence of any new neurological deficit. The study protocol follows the SPIRIT 2013 statement. Discussion It is possible that many neurosurgeons around the globe are tenting the dura in elective craniotomies which brings no benefit and only extends the operation. Unfortunately, there is not enough data to support or reject this technique in modern neurosurgery. This is the first study that may produce strong, evidence-based recommendations on using dural tenting sutures. Trial registration, ethics and dissemination The Bioethics Committee of the Medical University of Warsaw approved the study protocol (KB/106/2018). The trial is registered at http://www.clinicaltrials.gov (NCT03658941) on September 6, 2018. The findings of this trial will be submitted to a peer-reviewed neurosurgical journal. Abstracts will be submitted to relevant national and international conferences. Trial status Protocol version and date: version 1.5, 14.01.2020 First recruitment: September 7, 2018 Estimated recruitment completion: September 1, 2021

Factors Influencing the Surgical Outcomes of Extradural Haematoma

Background: Extradural Haematoma can occur in different reasons. Objective: The purpose of the present study was to see the factors influencing the surgical outcomes of extradural haematoma. Methodology: This cross-sectional study was conducted in the Department of Neurosurgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2010 to June 2011 for a period of one year and six months. All patients presented with traumatic head injury having extradural haematoma in any age with both sexes who were underwent surgical or conservative management were selected as study population. The etiologies of head injuries were recorded. Result: Eighty (80) patients of traumatic head injury within and after 24 hours of head injury were enrolled in this study. In this study road traffic accident was the most common mode of injury which was 51(63.8%) cases followed by fall from height and assault which were 16(20.0%) cases and 13(16.2) cases respectively. Majority patients were recovered in good condition either surgery or conservative management which was 50(62.5%) cases. However, the moderate disability was reported in 17(21.2%) cases. Severe disability was found in 8(10.0%) cases. Persistent vegetative state was found in only 2 cases in conservative treatment. Death was found in 3(3.8%) cases. Conclusion: In conclusion road traffic accident is the most common mode of injury among the study population that causes extra dura haematoma which has the role as factors that influence the outcomes of the patients. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 65-68